title: Outcome of pathologic fractures of the proximal femur in nonosteogenic primary bone sarcoma.
abstract: Pathologic fractures of the proximal femur resulting from primary bone sarcomas are often difficult to treat and some are often not recognized resulting in inappropriate interventions prior to the correct diagnosis being made. The aim of the study was to identify factors determining the survival after pathologic fractures of the proximal femur resulting from nonosteogenic primary bone sarcomas.
  
  
  METHODS
  We retrospectively reviewed 72 patients with nonosteogenic primary bone sarcomas of the proximal femur (chondrosarcoma in 34 patients, spindle cell sarcoma in 25 and Ewing's sarcoma in 13). There were 40 male and 32 female patients. The mean age was 49 years. We analyzed patient, tumor, and treatment factors in relation to overall survival. The mean follow up was 55 months (range 0-302 months).
  
  
  RESULTS
  The overall 5-year survival rate was 44% (Ewing's sarcoma 60%, chondrosarcoma 57%, spindle cell sarcoma 30%, and dedifferentiated chondrosarcoma 0%). The diagnosis of spindle cell sarcoma and dedifferentiated chondrosarcoma was the only significant factor adversely affecting survival. There was no difference in survival resulting from timing of the fracture, site of the fracture, age at diagnosis, surgical margin, limb salvage or amputation.
  
  
  CONCLUSIONS
  The key-factor adversely affecting the survival after pathologic fractures of the proximal femur resulting from nonosteogenic primary bone sarcomas is the histological diagnosis of dedifferentiated chondrosarcoma and spindle cell sarcoma.
authors.affiliation: Royal Liverpool and Broadgreen University Hospitals NHS Trust, Orthopaedics, Prescott Street, Liverpool, United Kingdom. crc12@hotmail.com
authors.forename: C R
authors.initials: CR
authors.lastname: Chandrasekar
authors.forename: R J
authors.initials: RJ
authors.lastname: Grimer
authors.forename: S R
authors.initials: SR
authors.lastname: Carter
authors.forename: R M
authors.initials: RM
authors.lastname: Tillman
authors.forename: A T
authors.initials: AT
authors.lastname: Abudu
authors.forename: L M
authors.initials: LM
authors.lastname: Jeys
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical; D001707:Biopsy, Needle; D001859:Bone Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D002648:Child; D002813:Chondrosarcoma / Q000150:complications / Q000628:therapy; D005260:Female; D005264:Femoral Fractures / Q000209:etiology* / Q000628:therapy*; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000209:etiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011379:Prognosis; D012189:Retrospective Studies; D012509:Sarcoma / Q000150:complications* / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D012512:Sarcoma, Ewing / Q000150:complications / Q000628:therapy; D016896:Treatment Outcome